Tablets, Creams and Supplements for Knee Arthritis
Paracetamol, anti-inflammatories, anti-inflammatory creams, glucosamine, chondroitin, fish oil, turmeric and opioids for knee arthritis — each measured against the Australian clinical guideline.
This page covers everything taken by mouth or rubbed on, from pharmacy shelves to prescription. Each is measured against the Australian guideline, and the answers are more mixed than either the supplement industry or the sceptics suggest.
The summary
| What the Australian guideline says | |
|---|---|
| Paracetamol | No recommendation either way — reasonable to trial |
| Anti-inflammatory creams | No recommendation either way — reasonable to trial |
| Oral anti-inflammatories | Effective; limited by safety, not by benefit |
| Glucosamine | Suggested not to be offered |
| Chondroitin | Suggested not to be offered |
| Fish oil (omega-3) | Suggested not to be offered |
| Opioids (tablets or patches) | Not recommended |
Paracetamol
The default first thing most people reach for, and weaker than its reputation.
Good-quality reviews have found the pain relief paracetamol provides in knee osteoarthritis is minimal — small enough that whether it is clinically meaningful is genuinely debatable. The Australian guideline makes no recommendation either way while noting it may be reasonable to trial.
It is very safe at correct doses, so trying it is sensible. The useful discipline is to notice whether it is actually helping, rather than continuing it indefinitely because it is what one does. If it is not doing anything, it is not doing anything.
Anti-inflammatory creams
Often the most sensible starting point, and routinely overlooked.
The knee is a relatively superficial joint — much of it sits just under the skin — which makes it well suited to a topical anti-inflammatory in a way a hip is not. Very little is absorbed into the bloodstream, so the stomach, kidney and cardiovascular risks that limit tablets largely do not apply.
The Australian guideline makes no recommendation either way. Several international guidelines are more positive, placing topical anti-inflammatories first-line for knee osteoarthritis, particularly for people over 75.
Given the favourable safety balance, a topical anti-inflammatory is often worth trying before an oral one. Apply it to the knee itself rather than a general area, and give it a fair trial of a week or two rather than a single application.
Oral anti-inflammatories
More effective than paracetamol for knee arthritis pain. That is the straightforward part.
The complication is safety. They carry real risks — stomach irritation and bleeding, kidney impairment, raised blood pressure, and cardiovascular risk — and those risks rise with age, with duration of use, with kidney disease, and with other medications including blood thinners and some blood pressure drugs.
This makes them well suited to short courses for flares and poorly suited to continuous use over years. The decision belongs with your GP, who knows the rest of your medications and your kidney function. If you are taking them daily and long-term without that conversation having happened, it is worth having.
Glucosamine and chondroitin
The most-purchased supplements for joint pain, and the guideline position is clear: suggested not to be offered — individually or combined.
This surprises people, partly because they have been recommended for decades and partly because plenty of people are convinced they help. Both things can be true at once: the average effect across good trials is not distinguishable from placebo, and a placebo response to a treatment you believe in is a real experience.
They are not dangerous. If you take them, feel better, and the cost does not bother you, there is no strong reason to stop. But if you are weighing whether to start — or spending meaningfully every month on them — that money buys a considerable amount of supervised exercise, which is the treatment with the strongest evidence in this entire section.
Fish oil, turmeric and the rest
The Australian guideline suggests not offering omega-3 fatty acids for knee osteoarthritis.
Turmeric and curcumin have some small studies suggesting benefit. The evidence is not strong enough to recommend them, and it is not strong enough to be confident they do nothing either. They sit in genuine uncertainty.
Neither is dangerous for most people. Do mention them to your GP or pharmacist though — fish oil can interact with blood thinners, and supplements are frequently omitted when people list their medications.
Opioids
Not recommended — the guideline is explicit, for both tablets and patches.
The evidence for benefit in knee osteoarthritis is poor, and the risks are not: dependence, falls in older people, constipation, cognitive effects, and tolerance that pushes doses up for diminishing return.
If you are on opioids for knee arthritis, this is not a criticism — it is a common situation and often arrived at reasonably, one step at a time. It is a reason to revisit the plan with your GP, ideally including whether the knee has reached the point where surgery is the better answer. Pain that severe is information.
What to take from this
The medications are for making the knee tolerable while you do the things that change it. None of them alters the arthritis, and none is a long-term plan on its own.
A reasonable sequence for most people: try a topical anti-inflammatory, use paracetamol if it genuinely helps, keep oral anti-inflammatories for flares and take them with your GP’s knowledge, and put the money you might spend on supplements into exercise instead.
Back to the overview.
Does glucosamine work for knee arthritis?+
The Australian guideline suggests not offering glucosamine for knee osteoarthritis, and the same for chondroitin and for the two combined. It is not dangerous and people who feel it helps are not imagining their experience, but the evidence does not support recommending it. Given it is usually an ongoing out-of-pocket cost, that money generally does more good spent on supervised exercise.
Does paracetamol help knee arthritis pain?+
Less than most people assume. The Australian guideline makes no recommendation either for or against paracetamol, noting it may be reasonable to trial, and good-quality reviews have found the pain relief it provides in knee osteoarthritis is minimal. It is very safe at correct doses, so trialling it is sensible — but if it is not helping, continuing it out of habit is not achieving much.
Are anti-inflammatory tablets good for knee arthritis?+
Oral anti-inflammatories are generally more effective than paracetamol for knee osteoarthritis pain, which is why international guidelines place them ahead of it. The limitation is safety rather than effectiveness — they carry stomach, kidney, blood pressure and cardiovascular risks that increase with age, duration of use and other conditions. They suit short courses for flares better than continuous long-term use, and the decision belongs with your GP, who knows your other medications.
Do anti-inflammatory creams work on knees?+
The Australian guideline makes no recommendation either for or against anti-inflammatory creams applied to the skin, while some international guidelines place them first-line for knee osteoarthritis, particularly in older patients. The knee is a relatively superficial joint, which suits topical treatment, and because very little is absorbed into the bloodstream the safety profile is much better than tablets. On that balance a topical anti-inflammatory is often a sensible thing to try first.
Should I take fish oil or turmeric for knee arthritis?+
The Australian guideline suggests not offering omega-3 fatty acids for knee osteoarthritis. Turmeric and curcumin have some small studies suggesting benefit but not evidence strong enough to recommend them. Neither is dangerous for most people, and if you take them and feel better there is no reason to stop — just be realistic about what they are likely to be contributing, and mention them to your GP, since fish oil in particular can interact with blood thinners.
Are opioids used for knee arthritis?+
They should not be. The Australian guideline does not recommend oral opioids or patches for knee osteoarthritis. The evidence for benefit in this condition is poor, the risks — dependence, falls, constipation, cognitive effects — are substantial, and tolerance means escalating doses for diminishing return. Persistent knee pain severe enough that opioids are being considered is a reason to reassess the whole plan, including whether surgery is warranted.